Veenker Herman, Paans Wolter
Hanze University of Applied Sciences, P.O. Box 70030, 9704 AA, Groningen, Netherlands.
, Zernikeplein 9, 9747 AS, Groningen, Netherlands.
BMC Med Educ. 2016 Oct 21;16(1):280. doi: 10.1186/s12909-016-0785-z.
Research within the framework of Self-Determination Theory (SDT) indicates that patients' autonomy is to be considered a critical health care outcome in its own right since it promotes improved mental and physical health. This paper presents an analysis of studies addressing communication and interaction interventions in health literacy curricula for medical and health care practitioners, focusing on patient-oriented skills in "making sense" and "to adapt and self-manage". For evaluating interventions, underlying communication models were traced. The criteria for good practice are "making sense" and "supporting autonomy in making choices". For the search of interventions, keywords from both the framework of the EU-project, Intervention Research on Health Literacy among Ageing population (IROHLA (The IROHLA project received financial support from the European Union through FP7 Grant 305831)), as well as the SDT (Self Determination Theory) were applied. The research question of this paper is to what degree is autonomy supporting communication skills part of the curricula of health literacy (HL) for medical and health care practitioners and providers? A Pubmed search revealed: a) that "making sense" is clearly represented in HL interventions in curricula; however, b) very few interventions teach medical and health care practitioners how to give autonomy support in the interaction with their (future) patients. Four promising, beneficial practices were identified. Several recommendations were presented encouraging curriculum developers to adapt skills of supporting autonomy into their programs.
A qualitative content analysis of interventions in the curricula of communication and interaction skills for medical students and practitioners.
A review of literature indicates: a) most interventions in curricula for medical students and practitioners are focusing on skills in adequately providing information to patients by using an underlying (advanced) Sender-Message-Receiver Model; and b) only a few interventions in curricula are available for providing the acquisition of interaction skills in supporting autonomy.
The proposal of Huber and others to change the emphasis in the definition of the WHO definition on health towards "to adapt and self manage" has impact on the training of medical students and practioners in dealing with patients with low levels of health literacy. From the present study it can be concluded that a dynamic approach to communication can be linked to theoretical constructs on self-management. In such an approach interaction techniques like scaffolding can increase the level of HL of the patient.
自我决定理论（SDT）框架下的研究表明，患者的自主性本身就应被视为一项关键的医疗保健成果，因为它能促进身心健康的改善。本文对针对医学和医护人员的健康素养课程中的沟通与互动干预研究进行了分析，重点关注“理解意义”和“适应与自我管理”方面以患者为导向的技能。为评估干预措施，追溯了潜在的沟通模型。良好实践的标准是“理解意义”和“在做出选择时支持自主性”。在搜索干预措施时，使用了欧盟项目“老年人群健康素养干预研究”（IROHLA（IROHLA项目获得了欧盟通过FP7资助305831提供的资金支持））框架以及自我决定理论（SDT）中的关键词。本文的研究问题是，支持自主性的沟通技能在多大程度上是医学和医护人员及提供者的健康素养（HL）课程的一部分？一项PubMed搜索显示：a）“理解意义”在课程中的HL干预措施中得到了明确体现；然而，b）很少有干预措施教导医学和医护人员如何在与（未来）患者的互动中给予自主性支持。确定了四种有前景且有益的实践。提出了几项建议，鼓励课程开发者将支持自主性的技能纳入他们的项目。
对医学生和从业者沟通与互动技能课程中的干预措施进行定性内容分析。
文献综述表明：a）医学生和从业者课程中的大多数干预措施侧重于通过使用潜在的（高级）发送者 - 信息 - 接收者模型向患者充分提供信息的技能；b）课程中只有少数干预措施可用于培养支持自主性方面的互动技能。
胡贝尔等人提出将世界卫生组织对健康定义中的重点转向“适应与自我管理”，这对医学生和从业者在应对健康素养水平较低患者方面的培训产生了影响。从本研究可以得出结论，动态的沟通方法可以与自我管理的理论构建联系起来。在这种方法中，像搭建脚手架这样的互动技巧可以提高患者的HL水平。
